I have read the Cablevision Access Rules and understand that this application must be submitted at least thirty (30) days prior to the requested date on this application. I also understand that a completed Access User Contract must be submitted at least fifteen (15) days prior to requested location date.

Applicant's Signature: ________________________________________

Date: ____________

Access Department Approval: ___________________________________

Date: ____________

Access Department Head Approval: ___________________________________

Date: ____________

Please fill out the above form, then click below to print it. Sign and date the form and mail or fax it to your regional access programming office.